Background and Aim: Carnitine deficiency contributes to various comorbidities in maintenance hemodialysis (MHD) patients. This study aims to assess the impact of levocarnitine supplementation on hematological and serum iron profile parameters, comparing the efficacy of oral versus intravenous (IV) administration in these patients. Materials and Methods: This was a multicenter, randomized controlled trial was conducted on patients undergoing MHD at the hemodialysis unit of our study center in Karachi, Pakistan. Eligible patients were randomly assigned to either the oral or IV groups. Patients in the oral group received levocarnitine tablets of 500 mg three times daily, while patients in the IV group received an IV bolus of levocarnitine at a dose of 20 mg/kg body weight, infused over 2–3 min directly into the IV line after each hemodialysis session. Both groups received intervention for a total of 24 weeks, and the final analysis included 49 patients from the oral group and 34 patients from the IV group. Results: The study involved 83 patients with a mean age of 44.72 ± 8.77 years, with a balanced distribution of 41 males and 42 females. The IV group showed a significant improvement in hemoglobin levels (mean increase: 0.57 g/dL, p < 0.001) and hematocrit (mean increase: 3.83%, p = 0.001), while the oral group showed only slight, nonsignificant changes in hemoglobin (mean increase: 0.07 g/dL, p = 0.22). Serum iron profile parameters improved significantly in both groups, though the IV group demonstrated greater enhancements across all parameters. Hematological parameter analysis revealed significant post‐intervention differences in hemoglobin, MCH, and MCHC, favoring the IV group. Conclusion: levocarnitine improves the hematological and iron profile in MHD patients. However, IV levocarnitine significantly more effective than oral administration. It notably improves hemoglobin, and enhances iron profile parameters. Trial Registration: ClinicalTrials.gov : NCT05817799.

Background and Aim: Accurate assessment of kidney function in patients with cirrhosis remains challenging due to the limitations of traditional biomarkers. This study aimed to compare the utility of serum creatinine (Cr) and cystatin C (Cys) in evaluating kidney function across different stages of disease severity. Methods: This prospective cross‐sectional study enrolled 120 participants at Jinnah Postgraduate Medical Centre, Karachi, Pakistan, comprising 30 healthy controls and 90 patients with cirrhosis, equally distributed across Child‐Pugh Classes A, B, and C. Comprehensive clinical assessment included measurement of serum Cr and Cys, with estimation of glomerular filtration rate (eGFR) using CKD‐EPI 2021 equations based on Cr, Cys, and combined Cr‐Cys. The Cr/Cys ratio was calculated to assess the degree of discordance between these biomarkers and kidney function was further classified into chronic kidney disease (CKD) stages according to the respective eGFR estimation methods. Results: Serum Cr was elevated in cirrhosis than controls with no difference between patient groups, whereas Cys showed a progressive increase with advancing cirrhosis and disease severity ( p < 0.001). The Cr/Cys ratio decreased consistently with increasing cirrhosis severity across groups, showing discordance between the two biomarkers. Correspondingly, Cys‐based and combined Cr‐Cys CKD‐EPI equations showed stepwise declines across Child‐Pugh Classes. Cr‐based equations predominantly classified patients as early‐stage CKD, while Cys‐based and combined equations identified more advanced dysfunction. Conclusion: Cys, alone or integrated with Cr in CKD‐EPI equations, provides a more sensitive assessment of kidney dysfunction with increasing cirrhosis and disease severity.

Background: Emotional intelligence (EI), empathy, and leadership are essential competencies in medical training, yet evidence from lower-middle-income countries such as Pakistan is limited. This study assessed EI among medical students and examined its association with empathy, authentic leadership, and sociodemographic factors. Methods: This cross-sectional study included 264 undergraduate medical students (years 2–5). EI was assessed using the Quick EI Scale measuring Emotional Awareness (EA), Emotional Management (EM), Social Emotional Awareness (SEA), and Relationship Management (RM). Empathy was evaluated using the Jefferson Scale of Empathy-Student Version (JSE-S), and leadership was measured using the Authentic Leadership Self-Assessment Questionnaire (ALQ) assessing Self-Awareness (SA), Internalized Moral Perspective (IMP), Balanced Processing (BP), and Relational Transparency (RT). Associations were analyzed using chi-square tests, ANOVA, and Spearman’s correlation (p<0.05). Results: Participants showed balanced gender representation (male: 49.6%, female: 50.4%) and were predominantly aged 21–23 years. Age and ethnicity demonstrated significant effects across multiple EI domains, with younger students showing higher EA (p=0.05) and SEA (p<0.001), while ethnicity significantly influenced EA (p=0.05), SEA (p=0.01), and RM (p<0.001). Extracurricular participation improved EM (p=0.03) and RM (p=0.03). In leadership domains, age affected SA (p=0.05), and ethnicity significantly predicted SA (p=0.05). Extracurricular involvement strongly enhanced IMP, BP, and RT (all p<0.001). Empathy increased with age (p<0.001), was higher among females (p=0.01), and was associated with autonomous career choice (p<0.001) and extracurricular participation (p<0.001). Academic year affected EA and empathy (p<0.001), with a U-shaped pattern final year students achieved highest scores (106.99±17.19) while fourth year showed lowest (93.89±19.49). EI correlated strongly with leadership, SEA most with empathy, and SA, BP, RT were significantly linked to empathy. Conclusion: EI, empathy, and leadership are interrelated competencies shaped by demographic, academic, and extracurricular factors. Incorporating structured EI and leadership development into medical curricula may help cultivate compassionate, emotionally intelligent physician-leaders.